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Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

  • Jason K. Wasserman (a1) (a2), Jeffrey J. Perry (a3) (a2), Dar Dowlatshahi (a4) (a2), Grant Stotts (a4) (a2), Marco L. A. Sivilotti (a5), Andrew Worster (a6), Marcel Emond (a7), Jane Sutherland (a3) (a2), Ian G. Stiell (a3) (a2) and Mukul Sharma (a8)...

Abstract

Objective

A cardiac source is often implicated in strokes where the deficit includes aphasia. However, less is known about the etiology of isolated aphasia during transient ischemic attack (TIA). Our objective was to determine whether patients with isolated aphasia are likely to have a cardioembolic etiology for their TIA.

Methods

We prospectively studied a cohort of TIA patients in eight tertiary-care emergency departments. Patients with isolated aphasia were identified by the treating physician at the time of emergency department presentation. Patients with dysarthria (i.e., a phonation disturbance) were not included. Potential cardiac sources for embolism were defined as atrial fibrillation on history, electrocardiogram, Holter monitor, atrial fibrillation on echocardiography, or thrombus on echocardiography.

Results

Of the 2,360 TIA patients identified, 1,155 had neurological deficits at the time of the emergency physician assessment and were included in this analysis, and 41 had isolated aphasia as their only neurological deficit. Patients with isolated aphasia were older (73.9±10.0 v. 67.2±14.5 years; p=0.003), more likely to have a history of heart failure (9.8% v. 2.6%; p=0.027), and were twice as likely to have any cardiac source of embolism (22.0% v. 10.6%; p=0.037).

Conclusions

Isolated aphasia is associated with a high rate of cardioembolic sources of embolism after TIA. Emergency patients with isolated aphasia diagnosed with a TIA warrant a rapid and thorough assessment for a cardioembolic source.

Objectif

L’origine cardiaque est souvent incriminée dans les accidents vasculaires cérébraux dans lesquels le déficit neurologique comprend de l’aphasie. Cependant, on connaît peu de choses sur la cause de l’aphasie isolée durant les accidents ischémiques transitoires (AIT). L’étude visait donc à déterminer si les patients atteints d’aphasie isolée étaient plus susceptibles de subir un AIT d’origine cardioembolique.

Méthode

Il s’agit d’une étude prospective de cohortes, composées de patients qui ont subi un AIT et qui ont été examinés dans 8 services d’urgence (SU) de soins tertiaires. Ceux qui présentaient des signes d’aphasie isolée étaient reconnus par le médecin traitant au moment de la consultation au SU. Les malades souffrant de dysarthrie (c’est-à-dire de troubles de la phonation) ont été écartés. Les sources possibles d’embolie d’origine cardiaque comprenaient la mention d’antécédents de fibrillation auriculaire (FA) à l’anamnèse; la présence de FA à l’électrocardiographie, à l’enregistrement de Holter ou à l’échocardiographie; ou encore la présence de thrombus à l’échocardiographie.

Résultats

Sur 2360 patients qui avaient subi un AIT, 1155 présentaient un déficit neurologique au moment de l’évaluation par l’urgentologue et ont été sélectionnés aux fins de l’analyse; parmi ceux-ci, 41 avaient comme seul déficit neurologique de l’aphasie isolée. Les patients atteints d’aphasie isolée étaient plus âgés que ceux qui étaient épargnés (73,9±10,0 contre [c.] 67,2±14,5 ans; p=0,003); ils étaient également plus susceptibles d’avoir des antécédents d’insuffisance cardiaque (9,8 % c. 2,6 %; p=0,027) et ils connaissaient deux fois plus de risques de subir un accident embolique d’origine cardiaque (22,0 % c. 10,6 %; p=0,037).

Conclusions

L’aphasie isolée est associée à un taux élevé d’embolie d’origine cardiaque à la suite d’un AIT. Aussi les patients examinés au SU pour de l’aphasie isolée chez qui un diagnostic d’AIT a été posé devraient-ils faire rapidement l’objet d’une évaluation complète à la recherche de causes cardioemboliques.

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Copyright

Corresponding author

Correspondence to: Dr. Jeffrey J. Perry, Clinical Epidemiology Unit, F647, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON K1Y 4E9; Email: jperry@ohri.ca

Footnotes

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Presentations: Presented at the Canadian Association of Emergency Physicians Annual Scientific Meeting, Newfoundland, Canada, June 2011 and at the International Stroke Conference, Los Angeles, CA, February 9-11, 2011.

Footnotes

References

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Keywords

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

  • Jason K. Wasserman (a1) (a2), Jeffrey J. Perry (a3) (a2), Dar Dowlatshahi (a4) (a2), Grant Stotts (a4) (a2), Marco L. A. Sivilotti (a5), Andrew Worster (a6), Marcel Emond (a7), Jane Sutherland (a3) (a2), Ian G. Stiell (a3) (a2) and Mukul Sharma (a8)...

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